Journal of Emergency Medicine最新文献_第4页

Gray-to-White Matter Ratio May Be Inadequate to Assess the Neurological Outcome of Patients with Hypoxic Brain Damage Due to Cardiac Arrest

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.09.001

Josef Finsterer MD, PhD

引用次数: 0

The Incidence of Delayed Intracerebral Hemorrhage After Head Trauma Under Anticoagulation Can Depend Strongly on the Quality of Anticoagulation

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.09.002

Josef Finsterer MD, PhD , Claudia Stollberger C, MD

引用次数: 0

Qualitative Study of Dynamics, Camaraderie, and Belonging Among Emergency Physicians and Nurses

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.011

Jeffrey Phillips MD, BSN , David Jones MD, MCR

{"title":"Qualitative Study of Dynamics, Camaraderie, and Belonging Among Emergency Physicians and Nurses","authors":"Jeffrey Phillips MD, BSN , David Jones MD, MCR","doi":"10.1016/j.jemermed.2024.08.011","DOIUrl":"10.1016/j.jemermed.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments (ED) must perform patient care at a safe and efficient pace, which requires an effective care team. Communication and workplace practices that foster identification as part of an emergency healthcare team have not been previously demonstrated.</div></div><div><h3>Objectives</h3><div>To explore the critical role of communication within ED healthcare teams and its impact on team belonging. This study investigates how communication practices between physicians and nurses in the ED influence team dynamics and the sense of belonging to the healthcare team.</div></div><div><h3>Methods</h3><div>A qualitative approach involving focus groups with 38 participants from nine EDs in Oregon.</div></div><div><h3>Results</h3><div>This study identifies positive influences on team belonging, such as proactivity, openness, less formal name conventions, and relationships outside of work. Conversely, negative influences include resistance to communication, obstacles to communication, and interactions leading to alienation.</div></div><div><h3>Conclusion</h3><div>The findings emphasize the importance of fostering positive communication practices to enhance team dynamics, cohesiveness, and overall well-being within ED healthcare teams. Future research may delve into specific aspects like naming conventions and the role of friendships in healthcare communication.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 43-50"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Characteristics of Intracranial Hemorrhage and Acute Aortic Syndromes Resuscitated with Extracorporeal Cardiopulmonary Resuscitation (ECPR)

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.014

Fumiya Inoue MD , Takayuki Otani MD , Toshikazu Abe MD, MPH, PhD , Akihiko Inoue MD, PhD , Toru Hifumi MD, PhD , Tetsuya Sakamoto MD, PhD , Yasuhiro Kuroda MD, PhD , The SAVE-J II Study Group

{"title":"Characteristics of Intracranial Hemorrhage and Acute Aortic Syndromes Resuscitated with Extracorporeal Cardiopulmonary Resuscitation (ECPR)","authors":"Fumiya Inoue MD , Takayuki Otani MD , Toshikazu Abe MD, MPH, PhD , Akihiko Inoue MD, PhD , Toru Hifumi MD, PhD , Tetsuya Sakamoto MD, PhD , Yasuhiro Kuroda MD, PhD , The SAVE-J II Study Group","doi":"10.1016/j.jemermed.2024.08.014","DOIUrl":"10.1016/j.jemermed.2024.08.014","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial hemorrhage (ICH) and acute aortic syndrome (AAS) are etiologies associated with unfavorable outcomes in patients with out-of-hospital cardiac arrest (OHCA), even with extracorporeal cardiopulmonary resuscitation (ECPR).</div></div><div><h3>Objectives</h3><div>This study aimed to describe the characteristics of refractory OHCA patients resuscitated with ECPR due to ICH and AAS.</div></div><div><h3>Methods</h3><div>This was a descriptive study and a secondary analysis of the SAVE-J II study, which was a multicenter ECPR registry.</div></div><div><h3>Results</h3><div>Among the 1589 cases, the causes of arrest were ICH in 48 patients (3%), AAS in 112 patients (7%), and cardiac causes in 1429 patients (90%). Patients in the ICH group were younger (ICH: 47 years [interquartile ranges (IQR) 40–63], AAS: 68 years [IQR 59–74], cardiac causes: 61 years [IQR 50–68]; <em>p</em> < 0.001), and had fewer signs of life on hospital arrival (ICH: 2%, AAS: 12%, cardiac causes: 19%; <em>p</em> = 0.001) compared to the cardiac causes group. Patients in the ICH and AAS groups were also less likely to present with an initial shockable rhythm (ICH, 19%; AAS, 27%; cardiac causes, 74%; <em>p</em> < 0.001). Survival to hospital discharge was significantly lower in the ICH and AAS groups than in the cardiac cause group (ICH, 4%; AAS, 4%; cardiac causes, 29%; <em>p</em> < 0.001). Of the 112 patients in the AAS group, 54 (48%) were presumptively diagnosed as cardiac etiologies before ECPR.</div></div><div><h3>Conclusion</h3><div>ICH and AAS should be considered potential causes of cardiac arrest, especially in cases with a nonshockable initial cardiac rhythm. However, differentiating them from cardiac causes of arrest remains challenging.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 1-12"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ultrasound-Guided Clavipectoral Plane Block for Analgesia of Acute Clavicular Fracture in the Emergency Department

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.020

Richard J. Gawel MD, Jeffrey A. Kramer MD, MSC

引用次数: 0

A Prospective Crossover Study Comparing Six Current Generation Supraglottic Airway Device's Ability to Seal During CPR in Human Cadavers

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.012

Joe Holley MD , Robert Dunne MD , Heather Robinson MD , Richard Williams RRT , Andisheh Motealleh PhD

{"title":"A Prospective Crossover Study Comparing Six Current Generation Supraglottic Airway Device's Ability to Seal During CPR in Human Cadavers","authors":"Joe Holley MD , Robert Dunne MD , Heather Robinson MD , Richard Williams RRT , Andisheh Motealleh PhD","doi":"10.1016/j.jemermed.2024.08.012","DOIUrl":"10.1016/j.jemermed.2024.08.012","url":null,"abstract":"<div><h3>Background</h3><div>Supraglottic airway (SGA) devices are frequently used during cardiopulmonary respiration (CPR), but little is known about their ability to consistently seal the airway during CPR.</div></div><div><h3>Objectives</h3><div>The objective of this prospective crossover human cadaver study was a comparison of intrathoracic pressures (ITPs) generated during automated CPR (aCPR) with an Impedance Threshold Device (ZOLL Medical Corporation, Chelmsford, MA) with six currently available SGAs to a standard endotracheal tube (ETT). The hypothesis was that current SGAs would vary in their ability to develop ITPs compared with the ETT.</div></div><div><h3>Methods</h3><div>Airway pressures and negative ITP were measured in six recently deceased human cadavers of varying body habitus. After placement of an ETT and six different SGAs, we assessed airway and ITPs during aCPR and manual positive pressure ventilation using bag-valve mask. The ETT served as the control for airway seal and was placed first followed by each SGA. Primary outcome compared airway and ITP among all groups.</div></div><div><h3>Results</h3><div>SGAs varied in their ability to create negative airway pressure and negative ITP.</div></div><div><h3>Conclusion</h3><div>In this human cadaver model, the ability to generate negative ITP varied with different SGAs during aCPR with an Impedance Threshold Device.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 25-31"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Managing Auricular Hematoma: An Emergency Medicine Narrative Review

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.08.021

Brit Long M.D , Jessica Mason M.D , Rachel E. Bridwell M.D , Michael Gottlieb M.D

{"title":"Managing Auricular Hematoma: An Emergency Medicine Narrative Review","authors":"Brit Long M.D , Jessica Mason M.D , Rachel E. Bridwell M.D , Michael Gottlieb M.D","doi":"10.1016/j.jemermed.2024.08.021","DOIUrl":"10.1016/j.jemermed.2024.08.021","url":null,"abstract":"<div><h3>Background</h3><div>Auricular hematoma is a condition commonly seen in the emergency department among patients presenting with trauma to the ear. It may result in several complications such as perichondritis and cauliflower ear if not managed appropriately.</div></div><div><h3>Objective</h3><div>This narrative review provides an evidence-based summary of the evaluation and management of auricular hematoma.</div></div><div><h3>Discussion</h3><div>Auricular hematoma is most commonly associated with shearing or blunt trauma to the ear, resulting in formation of a hematoma within the subperichondrial space. This hematoma obstructs the nutrient supply from the perichondrium to the avascular cartilage. Without a nutrient supply, the ear is at risk for infection, necrosis, and fibrocartilaginous deposition causing cauliflower ear. If a fluctuant hematoma is present within the cartilaginous auricle within 7 days of injury, evacuation should be offered. Prior to the procedure, analgesia should be performed using an auricular block. The hematoma can then be evacuated via needle aspiration or incision and drainage followed by a bolster compression dressing to prevent reaccumulation of blood within this potential space. Despite limited data, 7–10 days of antibiotics are currently recommended with coverage for <em>Pseudomonas aeruginosa</em> (eg, fluoroquinolones in adults, amoxicillin-clavulanate in children). This may mitigate the risk of perichondritis. Patients should be reevaluated at 24–48 hours and abstain from contact sports for at least 2 weeks.</div></div><div><h3>Conclusion</h3><div>Emergency clinicians must be knowledgeable regarding the evaluation and management of auricular hematoma, including the various drainage techniques.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 62-75"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Point-of-Care Ultrasound Diagnosis of Pyocele: A Rare Complication of Testicular Infection

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.09.008

Noman Ali MBBS, FCPS (EM), DRCPSC (PoCUS), Alan Tan MD, CCFP (EM), Jordan Chenkin MD MEd, FRCPC, DRCPSC (PoCUS)

{"title":"Point-of-Care Ultrasound Diagnosis of Pyocele: A Rare Complication of Testicular Infection","authors":"Noman Ali MBBS, FCPS (EM), DRCPSC (PoCUS), Alan Tan MD, CCFP (EM), Jordan Chenkin MD MEd, FRCPC, DRCPSC (PoCUS)","doi":"10.1016/j.jemermed.2024.09.008","DOIUrl":"10.1016/j.jemermed.2024.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Epididymo-orchitis is one of the common causes of acute scrotal pain that requires an accurate diagnosis as delayed management can result in complications such as pyocele, abscess, or testicular infarction. Point-of-care ultrasound (PoCUS) has emerged as a valuable diagnostic tool in the management of testicular emergencies in the emergency department (ED) including testicular infections</div></div><div><h3>Case Report</h3><div>Here we report a case of an elderly man who presented to the ED with a complaint of right-sided testicular pain and swelling. The diagnosis of pyocele was made using a PoCUS, facilitating an early referral to urology services.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>This case underscores the important role of PoCUS in the timely and accurate diagnosis of pyocele. The prompt identification of pyocele enabled early referral to urology services, highlighting the significance of integrating PoCUS into the management of testicular emergencies in the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 58-61"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acute Limb Ischemia: The Role of Physical Diagnosis in the Expedient Work-Up and Management in the Emergency Department—A Consultant's Perspective

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.09.007

Scott S. Berman MD, MHA, FACS, DFSVS

引用次数: 0

Impact of Extreme Temperature and Particulate Matter 2.5 on Outcomes of Out-of-Hospital Cardiac Arrest

IF 1.2 4区医学

Journal of Emergency Medicine Pub Date : 2025-02-01 DOI: 10.1016/j.jemermed.2024.10.014

Yongyeon Choi MPH , Sangshin Park MPH, PhD

{"title":"Impact of Extreme Temperature and Particulate Matter 2.5 on Outcomes of Out-of-Hospital Cardiac Arrest","authors":"Yongyeon Choi MPH , Sangshin Park MPH, PhD","doi":"10.1016/j.jemermed.2024.10.014","DOIUrl":"10.1016/j.jemermed.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Extreme temperature and particulate matter-2.5 (PM<sub>2.5</sub>) are known to affect the outcomes of out-of-hospital cardiac arrest (OHCA). However, studies that examine their effects at the exact time of OHCA occurrence are limited.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the impact of extreme cold, extreme heat, and PM<sub>2.5</sub> on OHCA outcomes at the time of occurrence.</div></div><div><h3>Methods</h3><div>We analyzed data from 82,497 OHCAs (aged > 18 years) in South Korea between January 2016 and December 2021. Extreme temperatures were defined as extreme cold (≤5th percentile) and extreme heat (≥95th percentile). PM<sub>2.5</sub> refers to particulate matter ≤ 2.5 micrometers, with extreme PM<sub>2.5</sub> defined as ≥95th percentile. The outcomes were survival to discharge and good neurological outcome, defined as a cerebral performance category of 1 or 2 at hospital discharge. We performed a multivariable logistic regression analysis to assess the impact of extreme temperature and PM<sub>2.5</sub> on OHCA outcomes.</div></div><div><h3>Results</h3><div>Extreme cold (-4.2°C to -20.2°C) showed no association with OHCA outcomes when compared to normal conditions (-0.9°C to 26.6°C). However, OHCAs during extreme heat (28.7°C to 39.3°C) showed a 15% significantly lower probability of survival to discharge (adjusted odds ratio [aOR]: 0.85, 95% confidence interval (CI): 0.74–0.98) compared to normal conditions. OHCAs during extreme PM<sub>2.5</sub> (56 to 218 µg/m³) were associated with 14% lower probability of survival to discharge (aOR: 0.86, 95% CI: 0.75–0.99) compared to normal PM<sub>2.5</sub> (0 to 43 µg/m³).</div></div><div><h3>Conclusion</h3><div>Extreme heat and PM<sub>2.5</sub> were significantly associated with a decreased probability of survival to discharge in OHCA patients.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"69 ","pages":"Pages 32-42"},"PeriodicalIF":1.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0